We appreciate the opportunity to respond to Dr. Wallace's thoughtful comments regarding our article on the impact of race and age on the association between body mass index (BMI) and cardiovascular disease (CVD) mortality in women.1
First, we completely agree with the importance of aggressive intervention of weight reduction and weight management for all segments of the population. This remains a critical public health issue and a major emphasis of our research. Clearly, cardiometabolic risks including hypertension and diabetes are strongly associated with obesity and visceral fat. The theme of our article, however, is the racial variation in the level of cardiovascular risks by body size.
The results are consistent with findings from numerous other studies, including an analysis indicating that while BMI and waist-hip ratio were strongly associated with blood pressure and hemoglobin a1c in all segments of the population, these parameters did not explain all the racial disparities in hypertension and diabetes.2 The consideration of varying levels of disease risks is important with regard to intervention, as there is not a simple single cure for CVD. Thus, population interventions focused on the prevention and control of CVD should be multiplicative in the approach and not based on a single strategy.
Dr. Wallace appropriately references the role of glucocorticoids and glucocorticoid receptors, which are strongly associated with visceral fat and central obesity. While our current study did not include measurements of central obesity, previous studies have also indicated that racial variation in waist-hip ratio did not explain the difference in risks of diabetes and hypertension.2
We agree completely with Dr. Wallace regarding the importance of public health intervention for CVD prevention for all segments of the population. However, the variation in disease risks for body mass would indicate that these interventions may produce different results for different individuals. Thus, population strategies should include the multiple parameters of the cardiometabolic syndrome.
REFERENCES
- 1.Abell JE, Egan BM, Wilson PWF, Lipsitz S, Woolson RF, Lackland DT. Age and race impact the association between BMI and CVD mortality in women. Public Health Rep. 2007;122:507–12. doi: 10.1177/003335490712200412. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Lackland DT, Orchard TJ, Keil JE, Saunders DE, Jr., Wheeler FC, Adams-Campbell LL, et al. Are race differences in the prevalence of hypertension explained by body mass and fat distribution? Findings from a survey in a biracial population. Int J Epidemiol. 1992;21:236–45. doi: 10.1093/ije/21.2.236. [DOI] [PubMed] [Google Scholar]